The purpose of the study "Validation of Quality Assessment Measures in EMS" is to investigate the utility of several data sources currently advocated for use in quality assurance programs, to determine the validity of each, and to select the most accurate, sensitive, and cost-beneficial for incorporation into an ongoing system for quality assessment of cases treated in a standard emergency service. Data collected from each source is examined for completeness and accuracy, using explicit detailed criteria. Four data sources are being considered: 1) the standard medical record, 2) a medical record completed by a "nurse-scribe" who takes dictation from the physican during the care process, 3) a structured checklist completed by the physician, 4) hospital billing records of resources consumed in the Emergency Room. The study is examining deficiencies in the medical record and seeking to develop an alternative means to generate the data required for a quality appraisal system. The records of 10,394 patients treated in the surgical area of the Yale-New Haven Hospital Emergency Service have been reviewed and abstracted onto special forms. This sample includes 3,187 lacerations, 218 burns, and 360 infection cases. A preliminary analysis of the laceration data has been completed, and the results document the deficiencies of a standard medical record from the perspective of quality appraisal and suggest specific modifications to improve the record.